Thursday, March 17, 2011

Bad Week


This has been a rough week for me.  Emotionally, Iv'e been kind of all over the map.  Some pretty high highs, and some pretty low lows.  And yeah, it's only Thursday.

I have this patient.  25 years old.  Came in for drug withdrawal.  Had a seizure in the ER due to drug withdrawal.  He has a pretty extensive medical and surgical history.  He was taking LOTS of pain medication (all prescribed by a "doctor" who should be fired and then shot, IMHO).  Said "doctor" made him an addict.  When his most recent prescription ran out, he couldn't fill it.  He went into detox.  Rapid, unsafe, and painful detox.  So his family brought him to our hospital.

He's tired of being addicted.  He wants help.  He wants to go to detox and drug rehab.  He's a really sweet kid who got mistreated by a "doctor" who wanted his money.  His family is supportive and also wants him to get the right tratment.  So I contacted his insurance company (well, the county funding agency, since he has no insurance).  They tell me that the county will not pay for detox for him because it'll take too long.  They'll send him to rehab with a methadone maintenence program (MMP).  I explain (nay, insist) that he doesn't want maintenance, he wants to be done with it.  Completely.  I'm basically told "tough shit."  Oh, and get him off the benzos before you call us back.  Bottom Hit #1.

So we tapered his benzos.  In the meantime, the family is getting more and more anxious.  I keep reassuring them that once he's medically stable, we'll do everything we can to get him into a good rehab program.  They're not crazy about the MMP but they'll take what they can get.

Benzo taper done.  I call his insurance back.  I'm told, "Why didn't you call us when you started to detox him?"  I reply, "Uh, I did.  Last week.  And you told me to get him off the benzos and you'd help me send him to rehab.  We did that.  He's ready to go."  I'm told, "He has to go to [x-facility]."  I reply, "He went to [x-facility] 2 years ago and was worse coming out than he was going in."  I'm basically told "tough shit."  Bottom Hit #2. 

Also, they require ID to approve the transfer.  His wife can't find his driver's license, but his mom has a copy of his passport.  I'm told, "That's not good enough - it has to be a state-issued photo ID with his adress on it."  I say, "Can't we use his passport and a utility bill?  They can't find his wallet!"  I'm basically told "tough shit."  I'm also told, "You'll have to discharge him and he'll have to go to the DMV tomorrow to get a driver's license then call me."  Aaaaan Bottom Hit #3.

Where's the high, you ask?  This kid seriously wants help.  Like, seriously.  Do you have any idea how rare that is?  Usually patients like this want "help" because they need a place to stay.  Not him.  He's done with the methadone.  Over it.  And that makes me happy.  For him.  For his wife.  For his family.  Also, his family brought me this huge beautiful bouquet of roses yesterday.  I cannot tell you how much that meant to me.  It is extremely rare that we get thanked, let alone shown appreciation.  I'm not trying to play the martyr here, it's just a fact.  I knew that going into this profession - it's a thankless, exhausting, frustrating job.  But when you get a bouquet of roses and hugs from your makes all the other bullshit totally worth it.  So today?  I felt like giving those roses back.  I feel like I completely let this patient and his family.  I feel like a failure.

So...yeah.  Rough week.  St. Patrick's Day is usually when I knock back a Guinness or two.  Tonight, I'm thinking Bailey's on the rocks is sounding more my speed.  [I'd say Jameson, but I'm an enormous liquor weenie]  What are your plans for St. Patrick's Day?  Celebrating the Luck o'the Irish, or drowning your sorrows (like a true Irishman)?

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